Forsus and Full Edgewise
In most moderate to severe non-extraction or borderline extraction Class II cases I use a two phase approach with the Xbow. With the borderline extraction cases if the case becomes too protrusive in phase two we then extract. In an extraction case we begin with headgear and start Class II elastics as soon as rectangular stainless steel arch wires are placed and space closure is begun. In deep bite cases we add a bite turbo as soon as there is incisor contact. Once the lower spaces are closed we decide whether to finish with headgear and elastics or place Forsus. The reason I use headgear and elastics is twofold. First, I don't like to wait to begin Class II mechanics until I have placed rectangular stainless steel arch wires. You may be missing out on growth, especially in late eruption or early maturing females. Second, in a deep bite case you want the posterior eruption that elastics give. Forsus is vertically neutral.
I use the same principles when using the Forsus device with a full edgewise appliance as I do with Xbow. Use the 22 or 25 mm Direct Pushrod distal to the lower first bicuspid instead of the canine, if possible. This keeps the Forsus device more compact and moves it distal to the anterior curvature of the arch, preventing sores. The only difference is you cannot fully compress the spring with an edgewise appliance if you use a bracket as the anterior stop. If you do be prepared to rebond the bracket. Don't forget to steel tie the first bicuspids. Reactivate the springs with crimpable stops on the rods or use longer rods.
Dr. Bob Miller taught us to hook up the pushrod using an Alastic KX module to activate the spring but at the same time remove the force from the canine or first bicuspid bracket. This also negates the need to cinch the distal end of the arch wire. Place the springs and pushrods as you would normally but don't close the loop yet. Make the pushrod adjustments leaving 1mm of play in the spring, remove the pushrod, pre-stretch a KX-1 module, place the KX module on the pushrod and close the loop, remove the arch wire from the mouth and place the pushrods on the archwire, replace the arch wire with the pushrods (do not cinch the distal end of the arch wire), tie in the arch wire, hook the KX module to the first molar hook using floss and a floss threader over the second bicuspid bracket and down between the second bicuspid and first molar, then place the pushrod in the spring. This completely activates the spring without debonding the canine or first bicuspid bracket. If we place the 22 mm or 25 mm pushrod distal to the first bicuspid we use a KX-1 module. We also use a KX-1 module distal to the canine in a bicuspid extraction case.
Alastic KX-1 module placed with floss threader
Alastic KX-1 module and lingual tuck-in pushrod adjustment
Alastic KX-1 module hook-up distal to canine (severe Class II, patient decided against mandibular advancement surgery after preparation)
Alastic KX-1 Module hook-up distal to first bicuspid
Alastic KX-1 Module hook-up distal to canine (bicuspid extraction) with a 22 mm pushrod.